Association between obstructive sleep apnea and temporomandibular disorders: A meta‐analysis

• Published in: Journal of oral rehabilitation 2024-10, Vol.51 (10), p.2220-2233
• Main Authors: Machado, Cláudia Aparecida de Oliveira, Resende, Camila Maria Bastos Machado, Stuginski‐Barbosa, Juliana, Porporatti, André Luís, Carra, Maria Clotilde, Michelloti, Ambra, Boucher, Yves, Simamoto Junior, Paulo Cezar
• Format: Article
• Language: English
• Subjects: Apnea; Check lists; Humans; Meta-analysis; obstructive sleep apnea; Polysomnography; Questionnaires; Sleep apnea; Sleep Apnea, Obstructive - complications; Sleep Apnea, Obstructive - physiopathology; Sleep disorders; systematic review; temporomandibular disorder; Temporomandibular joint; Temporomandibular joint disorders; Temporomandibular Joint Disorders - complications; Temporomandibular Joint Disorders - physiopathology
• ISSN: 0305-182X; 1365-2842; 1365-2842
• DOI: 10.1111/joor.13794

Background Obstructive sleep apnea (OSA) is a very common condition in patients with temporomandibular disorders (TMD). However, there is little evidence of a connection between them. Objective The aim of this systematic review and meta‐analysis is to assess the association between OSA and TMD in adult population. Methods Case–control, cross‐sectional and cohort studies on the association between TMD and OSA were searched in the EMBASE, LILACS, LIVIVO, PubMed/MEDLINE, Scopus, Web of Science, Google Scholar, Open Grey and Pro Quest databases. TMD should be assessed using Research Diagnostic Criteria (RDC/TMD) or Diagnostic Criteria (DC/TMD) and OSA using polysomnography (PSG) and/or a validated questionnaire. The risk of bias was evaluated using the Joanna Briggs Institute Critical Assessment Checklists; and an association meta‐analysis was performed. The effect measure included the odds ratio (OR) in dichotomous variables and a 95% confidence interval (CI). Certainty of evidence was determined by analysing groups using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results Out of the 1024 articles screened, 7 met the inclusion criteria for the qualitative synthesis, and 6 for quantitative analysis. All articles were classified at low risk of bias. A positive association with OSA was found in patients with TMD (OR = 2.61; 95% CI = 2.31, 2.95). A significant association was also found irrespective to the OSA diagnostic methods applied (for studies using PSG + validated questionnaires: OR = 2.74; 95% CI = 2.11, 3.57; for studies using validated questionnaires only: OR = 2.55; 95% CI = 2.22, 2.92). GRADE was moderate. Conclusion Patients with TMD presented a significant association with OSA regardless of the OSA diagnostic method (PSG and/or validated questionnaires). OSA screening should be part of the TMD examination routine. Furthermore, due to the different OSA assessment methods used and the small number of studies included, there is a need to include a larger number of studies using PSG to better elucidate this association. This meta‐analysis assessed the association between obstructive sleep apnea (OSA) and temporomandibular disorders (TMD) in adults. Case‐control, cross‐sectional and cohort studies OSA were searched in the EMBASE, LILACS, LIVIVO, PubMed/MEDLINE, Scopus, Web of Science, Google Scholar, Open Gray and Pro Quest databases. TMD should be assessed using RDC/TMD or DC/TMD and OSA using PSG and/or a validated qu